Clinical and demographic covariates of chronic opioid and non-opioid analgesic use in rural-dwelling older adults: the MoVIES project

Abstract

Background To describe covariates and patterns of late-life analgesic use in the rural, population-based MoVIES cohort from 1989 to 2002. Methods Secondary analysis of epidemiologic survey of elderly people conducted over six biennial assessment waves. Potential covariates of analgesic use included age, gender, depression, sleep, arthritis, smoking, alcohol, and general health status. Of the original cohort of 1,681, this sample comprised 1,109 individuals with complete data on all assessments. Using trajectory analysis, participants were characterized as chronic or non-chronic users of opioid and non-opioid analgesics. Multivariable regression was used to model predictors of chronic analgesic use. Results The cohort was followed for mean (SD) 7.3 (2.7) years. Chronic use of opioid analgesics was reported by 7.2%, while non-opioid use was reported by 46.1%. In the multivariable model, predictors of chronic use of both opioid and non-opioid analgesics included female sex, taking ≥2 prescription medications, and “arthritis” diagnoses. Chronic opioid use was also associated with age 75–84 years; chronic non-opioid use was also associated with sleep continuity disturbance. Conclusions These epidemiological data confirm clinical observations and generate hypotheses for further testing. Future studies should investigate whether addressing sleep problems might lead to decreased use of non-opioid analgesics and possibly enhanced pain management.

Opioid exposure is associated with nonunion risk in a traumatically injured population: An inception cohort study

“…In chronic pain patients, it has been estimated that 21% to 29% misuse opioids-meaning these medications are used contrary to the prescription-while 8% to 12% are addicted to opioids-meaning there is a pattern of continued use despite a demonstrated potential for harm [18]. Opioid use in our database is higher than in a 2007 California sample [19], and a nationally-representative sample from 2013 [20], but lower than reported in a 2008 sample from Utah [15], a national sample of Medicare patients with fragility fracture [7], a 2002 rural sample of elderly people in Pennsylvania [20], and a meta-analysis of patients with chronic pain [18].…”

The Role of Opioid Analgesics in Geriatric Pain Management

“…6–8 A recent study using data from the National Ambulatory Medical Care Survey showed that from 1999–2000 to 2009–2010, the percentage of clinic visits for older patients where an opioid was prescribed rose from 4.1% to 9.0%. 9 Most commonly, hydrocodone was used in combination with acetaminophen or ibuprofen.…”

“…19,22 Indeed, pharmacodynamic sensitivity helps explain risks of opioids unique to geriatric patients. 6,8,19,29,31 In a meta-analysis of pooled data from 6 observational studies, older adults exposed to opioids had a 38% increased likelihood of fractures (relative risk [RR] 1.38; 95% confidence intervals [CI] 1.15–1.66). 32 Moreover, timing of opioid initiation may be an important consideration.…”

Alcohol and drug use problems among older adults.

“…Long-term opioid use appears to be increasing over time, and older women may be vulnerable to using these medications for longer than recommended (Campbell et al, 2010). But evidence for increasing risk with age is mixed as individuals move into the oldest age-groups, such as those aged 75 and over (Han, Kass, Wilsey, & Li, 2013; Karp et al, 2013). Older adults with cognitive problems are at risk of taking inappropriate medications that can further impact their cognition (Weston, Weinstein, Barton, & Yaffe, 2010).…”